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Events, Medicine and Literature, Stanford News

Remembering the strange vigils of war through poetry and dance

Remembering the strange vigils of war through poetry and dance

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /In his Civil War-era poem, “Vigil Strange I Kept on the Field,” Walt Whitman describes watching over a soldier dying on the battlefield as a “vigil of silence, love and death.” That phrase may still ring true for soldiers fighting around the world; it may also feel familiar to medical professionals, whether imbedded in combat or in the ordinary rooms of a medical center. Yet this common experience is one that doctors and nurses reluctantly discuss and one that many soldiers and veterans feel lies beyond their powers of expression. A recent event held at StanfordHonoring the Ghosts – provided an exploration of such strange vigils through poetry and dance.

Alexander Nemerov, PhD, a Stanford art and art history professor, began the evening with a lecture, “Walt Whitman’s Moment.” During his talk he linked Whitman’s imagery of lamplight, starlight and shadow to contemporaneous art and popular depictions of the body, discussing the ways art freezes the human body and history freezes memory. Nemerov recalled the April 14 anniversary of the day Abraham Lincoln was shot in Ford’s Theatre. He quoted another Whitman poem, “When Lilacs Last in the Dooryard Bloom’d,” which commemorates Lincoln, and explained how poetry can simultaneously express private grief and offer public opportunities to honor and remember.

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /The longer portion of the evening consisted of dance performances by U.S. Marine Veteran Roman Baca’s Exit 12 Dance Company. The program notes explained that after serving as a Marine in the Iraq war, Baca felt “angry, depressed and aggressive.” With his wife and fellow ballet dancer Lisa Fitzgerald, Baca formed Exit 12 as a way to help him, and other veterans, tell their stories. Sunday’s performance at Stanford (the company’s West Coast debut) included seven dances that communicated a wide range of war experiences: a mother’s love and anxiety as her sons enlist; a soldier’s confusion as the demands of battle conflicted with fears for his family in Egypt. Two pieces, performed by solo dancers, were set to music and texts created by a veteran who teaches other vets to write poetry about their experiences; the impression of mental disintegration was terrifying.

My favorite piece was a solo in which the dancer stepped out of a camouflage uniform and performed an extended parting from the pile of clothes on the floor – the dance intimated for me both a soldier’s ambivalence about leaving the military and a human soul vacating a dead body on the battlefield.

A performance of Dance and Poetry exploring war trauma and recovery Honoring the Ghosts on Saturday, April 11, 2015, at the Stanford University Dinkelspiel Auditorium. ( Norbert von der Groeben /The evening ended with the company dancing in front of a large video screen which depicted Iraqi teenagers from different sects performing a dance they created under Baca’s guidance. The teens met in Arbil, Iraq, where Baca returned to share the gift of healing he had found in dance. The live dancers on the Dinkelspiel Auditorium stage repeated the movements of the Iraqi kids dancing on the screen, creating an effect of simultaneous action and memory, both in time and place, a performance both intensely personal and socially connected. The aspects of witness and healing shared between the performers and audience both honored the ghosts of the dead and acknowledged hopeful possibilities.

The event was sponsored by the Stanford Arts Institute, Stanford’s Medicine & the Muse Program in Medical Humanities and the Arts, and Stanford’s Department of Art & Art History.

Jennifer Swanton Brown, RN, MLA (’12) is manager of regulatory services and education, in Spectrum, the Stanford Center for Clinical & Translational Research & Education. She published her first poem in the Palo Alto Times when she was a fifth grader at Escondido Elementary School. Having served as a poet-teacher with California Poets in the Schools since 2001, she is currently serving as the second poet laureate for the City of Cupertino.

Previously: Prescribing a story? Medicine meets literature in “narrative medicine” and “Deconstructed Pain:” Medicine meets fine arts
Photos by by Norbert von der Groeben

Events, Medicine and Society, Stanford News

“You just get lifted away from the earth”: Film spotlights dance program for Parkinson’s patients

“You just get lifted away from the earth": Film spotlights dance program for Parkinson’s patients

capturing grace still

Tomorrow and Saturday, “Capturing Grace,” a documentary film following participants of a dance program for people with Parkinson’s disease generated by New York’s Mark Morris Dance Group (MMDG), will be screened at Stanford. Filmmaker and former KQED Forum host Dave Iverson, and David Leventhal, previously a leading dancer of MMDG and now the director of Dance for PD, will also be on campus holding workshops and discussions.

A Stanford News piece today describes the film as “the centerpiece of a two-day exploration of the intersection of dance and medicine” and offers these details:

Since his Parkinson’s diagnosis in 2004, Stanford alumnus Iverson has been an education champion for the progressive disorder of the nervous system that affects movement. He wrote, reported, directed and co-produced the 2009 PBS Frontline documentary My Father, My Brother and Me, using his family’s saga with the disease as a starting point to explore the larger issues of scientific research, the quest for a cure and the political controversies surrounding stem cell transplants. He also works as a contributing editor for the Michael J. Fox Foundation for Parkinson’s Research.

[Said Iverson:] “One thing I’ve come to believe about Parkinson’s is that it’s a disease of subtraction. It takes things from you one by one. And one of the many things I learned from the people in the class is that if you are confronted with a disease of subtraction, you better believe in addition. You better start adding things back into your life. For the people we profiled in Capturing Grace, I think dance helped get them back on the plus side of the ledger.”

I recently talked with Iverson, who told me that, despite his Frontline documentary’s title, “Capturing Grace” has proved more personally involving. “It’s more about what happens to people when they have to respond to something that’s unwelcome in their lives,” he said. The participants featured in the film gather at the MMDG studios in Brooklyn to take classes given by professional dancers of one of the world’s leading modern dance troupes, and they learn repertory to perform, including dances by Mark Morris.

“It isn’t a miracle and it’s not a treatment,” Morris says in the film. Different from art therapy, the program provides instruction in movement and an opportunity to share what professional dancers experience daily – the heightened sense of awareness found by coordinating one’s body and mind to move freely and deliberately through space, guided by music, in communion with others – with a deadline of a performance offering additional motivation to show up, practice, and stay focused on a goal.

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Big data, Events, Genetics, Stanford News, Videos

Using genetics to answer fundamental questions in biology, medicine and anthropology

Using genetics to answer fundamental questions in biology, medicine and anthropology

At last year’s Big Data in Biomedicine conference, Stanford geneticist Carlos Bustamante, PhD, spoke about the potential of using genetic information to answer fundamental questions in biology, medicine and anthropology. In this video from the 2014 event, Bustamante explains his lab’s efforts to better understand the structure of human genome, how genetic variations are portioned among different human populations and the significance of this information for designing medical genetic studies.

Bustamante will return to the Big Data in Biomedicine conference in May to moderate the genomics session. Speakers for the session are Christina Curtis, PhD, assistant professor of medicine and genetics at Stanford; Yaniv Erlich, PhD, assistant professor of computer science at Columbia University and a core member at the New York Genome Center; David Glazer, director of Engineering at Google and founder of the Google Genomics team; and Heidi Rehm, PhD, director of the Partners Laboratory for Molecular Medicine and associate professor of pathology at Harvard Medical School.

The conference will be held May 20-22 at the Li Ka Shing Center for Learning and Knowledge at Stanford; registration details can be found on the event website.

Previously: Big data used to help identify patients at risk of deadly high-cholesterol disorder, Examining the potential of big data to transform health care and Registration for Big Data in Biomedicine conference now open

Events, Obesity, Pediatrics, Stanford News, Videos

Childx speaker Matthew Gillman discusses obesity prevention

Childx speaker Matthew Gillman discusses obesity prevention

The inaugural Childx conference was held here last month, and video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

The prevalence of childhood obesity in the United States has not changed significantly since 2004 and remains at about 17 percent. However, the rate of obesity among preschool children, ages 2 to 5, has dropped from nearly 14 percent to 8.4 percent, according to data from the Centers for Disease Control and Prevention. Matthew Gillman, MD, a professor in the Department of Nutrition at Harvard Medical School, is among the group of researchers working to understand why rates of obesity among younger children have decreased.

In the above video interview from the Childx conference, Gillman discusses two possible reasons why fewer children under the age of five are obese and how this statistic points to potential prenatal underpinnings that influence a child’s risk of obesity. He goes on to explain how researchers previously believed that our health habits in adulthood gave rise to chronic disease, but that studies have shown the risk for these conditions may be determined early in life, even before birth. Watch his full interview to learn more about how fetal development influences our overall health.

Previously: “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy, Global health and precision medicine: Highlights from day two of Stanford’s Childx conference, Innovating for kids’ health: More from first day of Stanford’s Childx and “What we’re really talking about is changing the arc of children’s lives:” Stanford’s Childx kicks off

Addiction, Events, Pain, Patient Care, Public Health, Stanford News

The problem of prescription opioids: “An extraordinarily timely topic”

The problem of prescription opioids: "An extraordinarily timely topic"

photo (2) 2Suffer from pain? Or become an addict? Bemoan the epidemic of pain? Or decry the epidemic of opioid addiction?

At first glance, pain and addiction appear to conflict, to occupy distinct never-overlapping planes. But in reality, pain and addiction anchor two ends of a spectrum, with a lot of gray area in between, said Anna Lembke, MD, director of the Stanford Addiction Medicine Program.

Lembke and Sean Mackey, MD, PhD, chief of pain medicine, squared off in a good-natured debate of sorts moderated by chief communications officer Paul Costello last week at a Stanford Health Policy Forum on “The Problem of Prescription Opioids.”

“This is an extraordinarily timely topic,” Dean Lloyd Minor, MD, said in his introduction. “These issues really reflect a dilemma of wanting to bring the best compassionate care and science to our patients, yet also needing to respect the adverse effects that can occur.”

The statistics on both sides are sobering. The two experts told the audience that in the U.S., more than 16,000 people per year die of opioid overdose and 100 million people live in pain.

And both Lembke and Mackey shared harrowing tales of the suffering of their patients. Lembke once was called to consult on a women suffering from low back pain who had a opioid addiction identified by two previous psychiatrists. Yet in the exam room, the patient threatened to sue if she didn’t receive an opioid prescription, Lembke said. Cases like that prompted her to pen a provocative 2012 essay titled “Why doctors prescribe opioids to known opioid abusers.”

But Mackey treats patients who are suffering deeply, including a woman whose foot injury from a vehicle accident morphed into a pain syndrome affecting her upper extremities.

The current opioid addiction problem stems from a historical pattern of failing to treat pain, even in dying patients, Lembke said. Yet the pendulum swung too far and now doctors feel obligated to prescribe drugs such as opioids, she said.

At the Stanford Pain Management Center, teams of specialists work together to treat pain as a complex condition that affects many parts of the body and mind, Mackey said. Patients are treated with physical therapy, psychiatry and a variety of other specialties to try to allow them to participate in meaningful life activities, he said.

Although care at Stanford is top notch, it is an outlier and thousands of other patients are exposed to poor pain management practices. In addition, pain is now widely recognized as a disease, but addiction remains stigmatized, Lembke said.

When doctors recognize a opioid-seeking patient, they should treat the addiction, not boot the patient out of their practice.

Lembke and Mackey stressed that education about both pain and addiction ought to receive increased attention in medical schools. And patients need to take a role in treating both their own pain, and their addictions, they said. They do share common ground, Lembke said.

“All we think about every day is how we’re going to do it better,” Mackey said.

Previously: Assessing the opioid overdose epidemic, Stanford addiction expert: It’s often a “subtle journey” from prescription-drug use to abuse, Is a push to treat chronic pain pressuring doctors to prescribe opioids to addicts?, Why doctors prescribe opioids to patients they know are abusing them and Study shows prescribing higher doses of pain meds may increase risk of overdose
Photo by Becky Bach

Events, Parenting, Pediatrics, Stanford News, Videos

Pediatric health expert Alan Guttmacher outlines key issues facing children’s health today

Pediatric health expert Alan Guttmacher outlines key issues facing children's health today

The inaugural Childx conference was held here last month, and video interviews featuring keynote speakers, panelists and moderators are now on the Stanford YouTube channel. To continue the discussion of driving innovation in maternal and child health, we’ll be featuring a selection of the videos this month on Scope.

During his keynote speech at Stanford’s recent Childx conference, Alan Guttmacher, MD, director of the Eunice Kennedy Shriver National Institute of Child Health and Development, told attendees, “We need to be a society that values children.”

In the above video, Guttmacher emphasizes this point as he outlines key issues facing children’s health today. He explains that it’s the dawn of a new era in medical research with the potential to improve the lives of children throughout their life span. To make a lasting difference in children’s lives, he says, research needs to go beyond the medical approach and integrate social and environmental factors. He highlights the example of preterm birth, saying that while we’ve made strides in reducing the infant mortality rate of babies born too early, more needs to be done to understand the causes of preterm birth and prevent it.

Watch the full interview to learn more about why investing in pediatrics research can help the generations of tomorrow build a healthier future.

Previously: “It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy, Global health and precision medicine: Highlights from day two of Stanford’s Childx conference, Innovating for kids’ health: More from first day of Stanford’s Childx, “What we’re really talking about is changing the arc of children’s lives:” Stanford’s Childx kicks off and Countdown to Childx: Q&A with pediatric health expert Alan Guttmacher

Events, Global Health, History, Pediatrics, Surgery, Transplants

From Costa Rica to Stanford: Pediatric liver transplant surgeon shares his story

From Costa Rica to Stanford: Pediatric liver transplant surgeon shares his story

Esquivel - croppedThese days, Carlos Esquivel, MD, PhD, is best known as one of the top pediatric liver transplant surgeons. But just a few decades ago, he worked as a generalist physician in an ill-equipped Costa Rican village located across from a river teeming with man-sized crocodiles.

Esquivel told a gripping tale of his journey from his native Costa Rica to Stanford during a recent Café Scientifque presentation. He described how he spent only a year in remote San Vito before traveling to the United States and joining the lab of innovative surgeon F.W. Blaisdell, MD, who took Esquivel under his wing and treated him like a son. On to Sweden, where Esquivel earned his post-doctorate degree, before mastering his transplantation skills with Thomas Starzl, MD, PhD, who is known as the “father of trasnplantation” and conducted the first human liver transplant in 1963.

Back then, transplant surgeons wore knee-high fishing waders to perform transplantations — they were that messy, Esquivel said. And few dared to do liver transplants in children. Fast-forward to today: Transplant surgeries are shorter, much less bloody, and much more survivable thanks to the improvements in technology and immunosuppressant drugs. Last year, the team at Lucile Packard Children’s Hospital Stanford tallied a 100 percent one-year survival rate, Esquivel told the audience.

Now, the primary problem is the shortage of organs. More than 120,000 people in the United States are waiting for a new organ. Kidneys are most in-demand, but thousands of people are also waiting for new livers. And like kidneys, livers can be taken from living donors, Esquivel said. Sometimes, an adult liver can even be split in two, saving the lives of another adult and a child.

Livers can regenerate, making it an ideal organ to donate. However, the donation surgery can cause complications and donation is a choice that potential donors — and their doctors — should consider carefully, Esquivel said.

Esquivel said surgeries are physically taxing, but also take a great deal of mental preparation. Before surgeries, he said he runs through all the scenarios, trying to prepare for every possibility.

To raise awareness about organ donation, Esquivel, an avid cyclist, completed an across-the-county bicycle race with a former transplant patient. And he has high hopes for the future. Once, transplanted livers only lasted 12 to 15 years, but today, some livers last as long as 30 years, Esquivel said.

Previously: How mentorship shaped a Stanford surgeon’s 30 years of liver transplants, Raising awareness about rare diseases and Record number of organ transplants saves five lives in a day
Photo courtesy of Lucile Packard Foundation for Children’s Health/ Toni Gauthier

Events, Medicine X, Patient Care, Stanford News, Technology, Videos

Medicine X conference to focus on the theme of “Great eXpectations”

Medicine X conference to focus on the theme of "Great eXpectations"

Known for its powerful patient stories and candid on-stage conversations, the Medicine X conference returns to campus on Sept. 25-27. This year’s program will focus on the theme “Great eXpectations” and explore five key areas, including the challenges associated with accessing health care as you age, the misconceptions and misperceptions faced by patients and population health from the patient perspective.

In a press release about the upcoming conference, Lloyd Minor, MD, dean of the School of Medicine, noted, “The brightest minds and the most innovative thinking converge at Stanford Medicine X — the intersection of medicine and technology… This is one of the most thought-provoking and important events in health care today and will help pave the way for how technology enables patient-centered and patient-driven care in the years to come.”

During the three-day event, Peter Bach, MD, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, will deliver a keynote address. Bach is a physician and health-policy expert whose research focuses on the cost and value of anti-cancer drugs. An accomplished writer, he has authored numerous op-eds on health care, but is perhaps most well-known for his New York Magazine essay “The Day I Started Lying to Ruth” about losing his wife to cancer. Other confirmed speakers include cellist and composer Zoë Keating; Robert Pearl, MD, executive director and CEO of The Permanente Medical Group; and 91-year-old IDEO designer Barbara Beskind.

Registration for Medicine X is now open. More details about the program can be found on the Medicine X website.

More news about the conference is available in the Medicine X category.

Previously: Registration now open for the inaugural Stanford Medicine X|ED conference, Stanford Medicine X: From an “annual meeting to a global movement” and A doctor recounts his wife’s battle with cancer: “My knowledge was too clear-eyed”

Events, Medical Education, Medical Schools, Pediatrics, SMS Unplugged

A Match made at Stanford: From medical student to resident

A Match made at Stanford: From medical student to resident

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

IMG_1127On March 20, in synchrony with thousands of senior medical students across the country, I received an envelope that determined where I would be spending the next three years of my life for residency training.

My academic advisor, Oscar Salvatierra, MD, had come out of retirement to share this day with his students. He had supported us over the years, from studying for our first-year exams to choosing a specialty and applying to residency. He supported my husband and me in the additional challenges of tackling medical school as a married couple, guided us through my husband’s decision to pursue a combined MD/PhD degree, and even weighed in on our decision to have a child during medical school. Now, on Match Day, I was so grateful that he was the one to call my name and hand me my letter.

“Open. Open. Open,” my daughter demanded, grasping for the bright red envelope with the same steady persistence that she normally uses to ask for raisins. My husband took her from my arms so that my shaking fingers were free to open the envelope and unfold the letter. It was real, right there in black and white: I’ll be staying at Stanford for a pediatrics residency.

I grinned, then I cried, then I started soaking in the hugs and congratulations of my family, friends, and mentors who all knew how desperately I had hoped for this outcome. But the fun part about Match Day is that there is more than just your own news to celebrate. Within minutes, I was fighting through the crowds to track down my friends and classmates to find out where they had matched. I was incredibly impressed, but not at all surprised, to hear about the excellent programs they will be attending across the country.

As I stepped back into my apartment later that morning, clutching my residency Match letter, it felt a lot like bringing a newborn baby home from the hospital: it was odd and unsettling to walk back through familiar doors into my familiar home when our family’s life was all at once so deeply changed. In residency (like becoming a parent), I am going to have to work harder than I’ve ever worked before, and be challenged in ways I haven’t even imagined. But at the same time, I have no doubt that it will be worth it, and that this was exactly what I want for my life.

I hope that my classmates are feeling the same excitement to start the next phase of the journey. Congratulations to the Stanford Medicine Class of 2015 on an incredible Match!

Jennifer DeCoste-Lopez is a final-year Stanford medical student who will soon start a residency in pediatrics at Stanford. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

Events, Genetics, Patient Care, Pediatrics, Research, Stanford News, Stem Cells

“It’s not just science fiction anymore”: Childx speakers talk stem cell and gene therapy

“It’s not just science fiction anymore": Childx speakers talk stem cell and gene therapy

childx PorteusAt the Childx conference last week there was a great deal of optimism that stem cell and genetic therapies are about to have a huge impact on many childhood disease. “It’s not just science fiction anymore,” Matthew Porteus, MD, PhD, told the audience. “We can correct mutations that cause childhood disease.”

The session was hosted by Stanford professor Maria Grazia Roncarolo, MD, who until recently was head of the Italy’s Telethon Institute for Cell and Gene Therapy at the San Raffaele Scientific Institute in Milan. Roncarolo pointed out that there are more than 10,000 human diseases that are caused by a single gene defect. “Stem cell and gene therapies can be used to treat cancer and other diseases,” Roncarolo said.

Two such diseases are sickle cell disease and severe combined immune deficiency. In both cases, a single nucleotide change in DNA becomes a deadly defect for children with the bad luck to have them. Porteus is working on very new genome editing technologies that allow clinicians to go in and fix those DNA typos and cure diseases.

Stanford dermatology researcher Anthony Oro, MD, PhD is working to do something similar with skin cells for a painful blistering disease called epidermolysis bullosa. Children with EB lack a functional gene for one of the proteins that anchors the layers of skin together. Oro and Stanford Institute for Stem Cell Biology and Regenerative Medicine scientist Marius Wernig, MD, PhD, are taking defective skin cells from patients, transforming them into embryonic-like stem cells, fixing the gene defect, and then growing them back into skin stem cells and then layers of skin ready for transplantation. Oro says that they have shown that they can do this in a scalable way in mice, and they hope to start a clinical trial in humans soon.

One of the challenges to genetic therapy is that it often requires putting the gene into blood stem cells to deliver it to the body, but the high dose chemotherapy or radiation that is necessary to remove the bodies own blood stem cells and make way for the transplanted cells is very dangerous in itself. Researchers like Stanford researcher Hiromitsu Nakuchi, MD, PhD, are exploring gentler ways to make space in the body for the transplanted cells. He has discovered that simply by feeding mice a diet deficient in a particular amino acid, blood stem cells begin to die. Other cells in the body don’t seem to be as strongly affected. A dietary solution may eventually allow clinicians to avoid using the highly toxic treatments that have traditionally been used for blood stem cell transplant.

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